Experience the Eide Bailly DifferenceCompelling ClinicMetrics
Compelling Clinic Metrics              • David Manning, CPA,                CMPE              • Manager in Health Care    ...
Compelling Clinic Metrics Why did I choose “Compelling” Compelling means: • Forceful • Powerful • Convincing • Persuasive ...
Compelling Clinic Metrics The underlying idea: “There is no substitute for knowledge.”               and “You can expect w...
Compelling Clinic MetricsQuestions: So, what do we measure? How do we in turn that information into   knowledge? How do we...
Compelling Clinic MetricsCompelling Clinic Metrics    Would you board a commercial flight without    RADAR?    Or a mercha...
Compelling Clinic MetricsCompelling Clinic Metrics    Without regular reporting and benchmarking,    you’re flying blind. ...
Compelling Clinic MetricsCompelling Clinic Metrics    Granted, instruments and data do not fly the    plane – a good pilot...
Compelling Clinic MetricsWhat makes a good metric?Possible Criteria:• Objective (vs. Subjective)• Transparent (Verifiable)...
Compelling Clinic MetricsPros & Cons Analysis: Pros: • Ease of collection • Immediacy to behavior Cons: • Expense to colle...
Compelling Clinic MetricsEfficiency and Efficacy •   Efficiency is defined as maximizing profit for the     given disposab...
Compelling Clinic MetricsEfficiency and Efficacy of Clinic Metrics  Higher(Low cost) Efficient  Lower(High cost)          ...
Compelling Clinic MetricsEfficiency and Efficacy of Clinic Metrics  Higher(Low cost)                                      ...
Compelling Clinic MetricsCommon Types of Measures: 1.   Measures of Productivity 2.   Measures of Contribution 3.   Measur...
Compelling Clinic Metrics1.       Measures of Productivity     •    Productive Efficiency          (Ratio of what is produ...
Compelling Clinic Metrics2. Measures of Contribution  (Defined as the part played by a person or  thing in bringing about ...
Compelling Clinic Metrics4. Measures of Business Operations  (Defined as the business performance of  the clinic or organi...
Compelling Clinic Metrics1. Measures of Productivity                                                 Grading   Productive ...
Compelling Clinic Metrics1. Measures of Productivity   Productive Efficiency: 7.  Gross Revenue per provider FTE 8. Gross ...
Compelling Clinic Metrics1. Measures of Productivity   Productive Efficiency: 11. Ambulatory encounters per provider FTE 1...
Compelling Clinic Metrics1. Measures of Productivity   Productivity Capacity: 1. Provider Full Time Equivalent (FTE = hour...
Compelling Clinic Metrics1. Measures of Productivity   Productivity Capacity: 5.   Ratio of filled to available scheduled ...
Compelling Clinic Metrics2. Measures of Contribution   Helping to advance a goal or bring   about a result: 1.   Participa...
Compelling Clinic Metrics2. Measures of Contribution   Helping to advance a goal or bring   about a result: 5. Uncompensat...
Compelling Clinic Metrics3. Measures of Quality Never an easy subject – many different views: •  Transcendental - cannot d...
Compelling Clinic Metrics3. Measures of Quality •   PQRS (formerly PQRI) measures – Examples:       Diabetes Melitus: Lip...
Compelling Clinic Metrics3. Measures of Quality •   PQRS (formerly PQRI) measures •   E&M Code Distribution by provider • ...
Compelling Clinic Metrics4. Measures of Business Operations 1.   Total Accounts Receivable (A/R) by aging      category 2....
Compelling Clinic Metrics4.    Measures of Business Operations     7.    Business & Clinical staff hour splits (above     ...
Compelling Clinic MetricsWhat can you do with Compelling Clinic Metrics? Whatever metrics you use, they must be: - Underst...
Compelling Clinic MetricsWhat can you do with Compelling Clinic Metrics? Whatever metrics you use, they must be: - Reporte...
Compelling Clinic Metrics                            www. e ideba i l l y.c om
Compelling Clinic MetricsWhat can you do with Compelling Clinic Metrics? Benchmarking (using external comparisons) •   Use...
Compelling Clinic MetricsWhat can you do with Compelling Clinic Metrics? Benchmarking (using internal benchmarks) •   Usef...
Compelling Clinic MetricsWhat can you do with Compelling Clinic Metrics?                                         www. e id...
Compelling Clinic MetricsWhat can you do with Compelling Clinic Metrics? Planning Daily Clinic Schedules •   Establish ann...
Compelling Clinic MetricsWhat can you do with Compelling Clinic Metrics?    Setting Productivity Goals                    ...
Compelling Clinic MetricsWhat can you do with Compelling Clinic Metrics?Sample Family Practice Production - 6 month period...
Compelling Clinic MetricsWhat can you do with Compelling Clinic Metrics? Planning Daily Clinic Schedules •   Go ahead, ass...
Compelling Clinic MetricsBack to Basicswith LEGO Building Blocks                                          Example of 20.1 ...
Compelling Clinic MetricsBack to Basicswith LEGO Building Blocks                                     10:00                ...
Compelling Clinic Metrics                Back to Basics                with LEGO Building Blocks                          ...
Compelling Clinic Metrics                Back to Basics                with LEGO Building Blocks                          ...
Compelling Clinic MetricsWhat can you do with Compelling Clinic Metrics?  We used many metrics in assembling the    schedu...
Compelling Clinic MetricsRecap1. Measures of Productivity2. Measures of Contribution3. Measures of Quality4. Measures of B...
Compelling Clinic MetricsAnd finally, remember: If you link compensation to performance… Physicians become very interested...
Physician Clinic Profitability                 •   David Manning, CPA,                     CMPE                 • Manager ...
Physician Clinic Profitability        Who Has the First           Question?                                 www. e ideba i...
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Compelling Clinic Metrics 111711 Linked In

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Compelling Clinic Metrics for managing your physician practice

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Compelling Clinic Metrics 111711 Linked In

  1. 1. Experience the Eide Bailly DifferenceCompelling ClinicMetrics
  2. 2. Compelling Clinic Metrics • David Manning, CPA, CMPE • Manager in Health Care Consulting, Eide Bailly, LLP • Former manager of several clinics, both hospital-owned and private practice • T. 701-476-8334 • dmanning@eidebailly.com www. e ideba i l l y.c om
  3. 3. Compelling Clinic Metrics Why did I choose “Compelling” Compelling means: • Forceful • Powerful • Convincing • Persuasive • Demanding Attention www. e ideba i l l y.c om
  4. 4. Compelling Clinic Metrics The underlying idea: “There is no substitute for knowledge.” and “You can expect what you inspect.” - Edward Deming www. e ideba i l l y.c om
  5. 5. Compelling Clinic MetricsQuestions: So, what do we measure? How do we in turn that information into knowledge? How do we use the knowledge in managing a clinic? www. e ideba i l l y.c om
  6. 6. Compelling Clinic MetricsCompelling Clinic Metrics Would you board a commercial flight without RADAR? Or a merchant ship? www. e ideba i l l y.c om
  7. 7. Compelling Clinic MetricsCompelling Clinic Metrics Without regular reporting and benchmarking, you’re flying blind. www. e ideba i l l y.c om
  8. 8. Compelling Clinic MetricsCompelling Clinic Metrics Granted, instruments and data do not fly the plane – a good pilot is necessary for that. But a good pilot would never take off without working instruments. www. e ideba i l l y.c om
  9. 9. Compelling Clinic MetricsWhat makes a good metric?Possible Criteria:• Objective (vs. Subjective)• Transparent (Verifiable)• Independent• Discrete• Cyclical• Stable• Comparable (Common denominator) www. e ideba i l l y.c om
  10. 10. Compelling Clinic MetricsPros & Cons Analysis: Pros: • Ease of collection • Immediacy to behavior Cons: • Expense to collect • Multiple causes • Elements beyond control of employees • Difficult linkage to behavior www. e ideba i l l y.c om
  11. 11. Compelling Clinic MetricsEfficiency and Efficacy • Efficiency is defined as maximizing profit for the given disposable resources. • Efficacy is defined as the power or capacity to produce a desired result (i.e., effectiveness). • It is possible to be effective while being inefficient, to be efficient while being ineffective, to be both, and (unfortunately) to be neither. www. e ideba i l l y.c om
  12. 12. Compelling Clinic MetricsEfficiency and Efficacy of Clinic Metrics Higher(Low cost) Efficient Lower(High cost) Lower Effective Higher www. e ideba i l l y.c om
  13. 13. Compelling Clinic MetricsEfficiency and Efficacy of Clinic Metrics Higher(Low cost) Measure #1 Efficient Measure #3 Lower Measure #2(High cost) Lower Effective Higher www. e ideba i l l y.c om
  14. 14. Compelling Clinic MetricsCommon Types of Measures: 1. Measures of Productivity 2. Measures of Contribution 3. Measures of Quality 4. Measures of Business Operations www. e ideba i l l y.c om
  15. 15. Compelling Clinic Metrics1. Measures of Productivity • Productive Efficiency (Ratio of what is produced to what is required to produce it) • Productive Capacity (Ratio of used to installed productive capacity) www. e ideba i l l y.c om
  16. 16. Compelling Clinic Metrics2. Measures of Contribution (Defined as the part played by a person or thing in bringing about a result or helping something advance)3. Measures of Quality (Transcendental view, Product-based view, User-based view, Manufacturing-based view, Value-based view, etc.) Garmin, “Managing Quality” www. e ideba i l l y.c om
  17. 17. Compelling Clinic Metrics4. Measures of Business Operations (Defined as the business performance of the clinic or organization unit inclusive of providers and other support staff) Garmin, “Managing Quality” www. e ideba i l l y.c om
  18. 18. Compelling Clinic Metrics1. Measures of Productivity Grading Productive Efficiency: 1. Gross Revenue per provider 2. Contractual adjustments per provider 3. Net Revenue per provider 4. CPT procedure code volumes per provider 5. Work Relative Value Units per provider 6. Ambulatory encounters per provider www. e ideba i l l y.c om
  19. 19. Compelling Clinic Metrics1. Measures of Productivity Productive Efficiency: 7. Gross Revenue per provider FTE 8. Gross Revenue per staffed & available patient schedule hour 9. Work Relative Value Units per provider FTE 10. Work Relative Value Units per schedule hour www. e ideba i l l y.c om
  20. 20. Compelling Clinic Metrics1. Measures of Productivity Productive Efficiency: 11. Ambulatory encounters per provider FTE 12. Staff Hours per provider FTE 13. Staff Hours per provider WRVU 14. Staff Hours per schedule hour www. e ideba i l l y.c om
  21. 21. Compelling Clinic Metrics1. Measures of Productivity Productivity Capacity: 1. Provider Full Time Equivalent (FTE = hours worked per week/normal number of weekly hours for full time employee) 2. Provider clinic days per week/month 3. Schedule hours (staffed & available) per week/month (e.g. appointments, slots, etc.) 4. Patient appointments per day (per week, average/day, etc.) www. e ideba i l l y.c om
  22. 22. Compelling Clinic Metrics1. Measures of Productivity Productivity Capacity: 5. Ratio of filled to available scheduled appointments (staffed & available) 6. Wait time to next available scheduled appointment 7. Walk-in appointments per day/week 8. Ratio of filled to available walk-in appointments www. e ideba i l l y.c om
  23. 23. Compelling Clinic Metrics2. Measures of Contribution Helping to advance a goal or bring about a result: 1. Participation in medical staff activities 2. Staff supervision or mentoring (mid-levels, residents, etc.) 3. Timely completion of charting activities (hospital & clinic) 4. Uncompensated administrative duties (directorships, committees, education, etc.) www. e ideba i l l y.c om
  24. 24. Compelling Clinic Metrics2. Measures of Contribution Helping to advance a goal or bring about a result: 5. Uncompensated care activities (outside of organization) 6. Community involvement 7. Marketing and networking activities 8. Public support of organizational mission & objectives www. e ideba i l l y.c om
  25. 25. Compelling Clinic Metrics3. Measures of Quality Never an easy subject – many different views: • Transcendental - cannot describe, but you know it when you see it • Product-based – quantifiable and measurable characteristics used to define quality (PQRS/PQRI) • User-based – that which best satisfies the consumer defines quality • Manufacturing-based – products best conforming to design and delivery standards define quality • Value-based – defined by consumer in terms of service experience and price www. e ideba i l l y.c om
  26. 26. Compelling Clinic Metrics3. Measures of Quality • PQRS (formerly PQRI) measures – Examples:  Diabetes Melitus: Lipid Profile within last 18 months  Asthma: Tobacco Exposure Screening Queried within last 12 months  Asthma: Tobacco Use Screening Queried within last 12 months  Hypertension: Plan of Care documented within last 12 months www. e ideba i l l y.c om
  27. 27. Compelling Clinic Metrics3. Measures of Quality • PQRS (formerly PQRI) measures • E&M Code Distribution by provider • Patient satisfaction survey • No-show appointments • Patient willingness to see next available provider • Trend monthly referrals by referring provider • New patient appointments www. e ideba i l l y.c om
  28. 28. Compelling Clinic Metrics4. Measures of Business Operations 1. Total Accounts Receivable (A/R) by aging category 2. Days in A/R 3. Active A/R (versus A/R in outside collections) 4. Total Staff Hours 5. Total Staff Hours per ambulatory encounter 6. Total Staff Hours per patient schedule hour www. e ideba i l l y.c om
  29. 29. Compelling Clinic Metrics4. Measures of Business Operations 7. Business & Clinical staff hour splits (above metrics) 8. Average days to file clean claim 9. Days from payment receipt to posting in system 10. Adjustment codes for past timely filing 11. Financial performance to budgeted performance 12. Referral source trend analysis www. e ideba i l l y.c om
  30. 30. Compelling Clinic MetricsWhat can you do with Compelling Clinic Metrics? Whatever metrics you use, they must be: - Understood by providers - Objective (not subjective by data gatherers) - Reliable (stable) - Re-calculable (transparent) - Linked to behaviors under the control of providers and/or clinic staff www. e ideba i l l y.c om
  31. 31. Compelling Clinic MetricsWhat can you do with Compelling Clinic Metrics? Whatever metrics you use, they must be: - Reported regularly & consistently - Presented with prior periods - Visual presentation (graph), if possible - Focused (suggestion of 6-10 metrics) www. e ideba i l l y.c om
  32. 32. Compelling Clinic Metrics www. e ideba i l l y.c om
  33. 33. Compelling Clinic MetricsWhat can you do with Compelling Clinic Metrics? Benchmarking (using external comparisons) • Useful for assessing current performance and setting future performance goals • Useful for gaining consensus among providers and clinic staff • Sources: 1. MGMA 2. AMGA 3. State associations 4. Applicable specialty associations or organizations www. e ideba i l l y.c om
  34. 34. Compelling Clinic MetricsWhat can you do with Compelling Clinic Metrics? Benchmarking (using internal benchmarks) • Useful over time for monitoring change and progress toward goals • Useful for comparing performance between providers within the organization • Wide range of metrics are available without regard for external benchmark parameters www. e ideba i l l y.c om
  35. 35. Compelling Clinic MetricsWhat can you do with Compelling Clinic Metrics? www. e ideba i l l y.c om
  36. 36. Compelling Clinic MetricsWhat can you do with Compelling Clinic Metrics? Planning Daily Clinic Schedules • Establish annual/monthly/weekly/daily production goals • Use these goals to build a clinic schedule from the bottom up www. e ideba i l l y.c om
  37. 37. Compelling Clinic MetricsWhat can you do with Compelling Clinic Metrics? Setting Productivity Goals MGMA Median Specialty Annual WRVUs Family Practice without OB 4,819 Weeks per year 52 weeks Less: CME -2 weeks Less: PTO -4 weeks Less: 5 Holidays -1 weeks Net clinic work weeks 45 weeks Total WRVUs per week 107.1 WRVUs Clinic days per week 4 days Total WRVUs per day 26.8 WRVUs Non-clinic WRVUs 25% Clinic WRVUs per day 20.1 WRVUs www. e ideba i l l y.c om
  38. 38. Compelling Clinic MetricsWhat can you do with Compelling Clinic Metrics?Sample Family Practice Production - 6 month period 6-Month 2011 CMS 6-Month Percent of Estimated CPT Description Count WRVUs Tot WRVUs Tot WRVUs Daily Count 17000 Destruct premalg lesion 5 0.65 3.25 2% 1 17003 Destruct premalg les 2-14 3 0.07 0.21 0% 1 17110 Destruct b9 lesion 1-14 4 0.70 2.8 2% 1 99202 Office/outpatient visit new 2 0.93 1.86 1% 1 99203 Office/outpatient visit new 1 1.42 1.42 1% 1 99204 Office/outpatient visit new 1 2.43 2.43 2% 1 99211 Office/outpatient visit est 1 0.18 0.18 0% 1 99212 Office/outpatient visit est 17 0.48 8.16 6% 2 99213 Office/outpatient visit est 102 0.97 98.94 67% 14 99214 Office/outpatient visit est 16 1.50 24 16% 4 99215 Office/outpatient visit est 2 2.11 4.22 3% 1 147.47 28 www. e ideba i l l y.c om
  39. 39. Compelling Clinic MetricsWhat can you do with Compelling Clinic Metrics? Planning Daily Clinic Schedules • Go ahead, assemble your day… www. e ideba i l l y.c om
  40. 40. Compelling Clinic MetricsBack to Basicswith LEGO Building Blocks Example of 20.1 WRVUs - Daily WRVU Target Existing Patient New Pt Other E&Ms E&Ms Proc 1 1 1 1 2 1 1 1 1 2 3 4 5 6 7 8 9 10 11 12 13 14 1 1 2 3 4 1 www. e ideba i l l y.c om
  41. 41. Compelling Clinic MetricsBack to Basicswith LEGO Building Blocks 10:00 10:30 11:00 11:30 12:00 12:30 13:00 13:30 14:00 14:30 15:00 15:30 16:00 16:30 8:00 8:30 9:00 9:30Room 1 LUNCHRoom 2 LUNCH www. e ideba i l l y.c om
  42. 42. Compelling Clinic Metrics Back to Basics with LEGO Building Blocks 10:00 10:30 11:00 11:30 12:00 12:30 13:00 13:30 14:00 14:30 15:00 15:30 16:00 16:30 8:00 8:30 9:00 Room 1 1 2 3 9:304 5 6 7 8 LUNCH 1 9 10 11 12 13 142 Room Option 1 2 1 1 1 1 1 1 Room 2 1 LUNCH 1 2 3 4 www. e ideba i l l y.c om
  43. 43. Compelling Clinic Metrics Back to Basics with LEGO Building Blocks 10:00 10:30 11:00 11:30 12:00 12:30 13:00 13:30 14:00 14:30 15:00 15:30 16:00 16:30 8:00 8:30 9:00 9:30 1 1 Room 1 1 1 4 7 LUNCH 1 9 11 13 1 13 Room Option 1 1 Room 2 3 6 LUNCH 1 10 4 2 1 Room 3 2 5 8 LUNCH 2 3 12 14 www. e ideba i l l y.c om
  44. 44. Compelling Clinic MetricsWhat can you do with Compelling Clinic Metrics? We used many metrics in assembling the schedule: • CPT Procedures • WRVUs • Benchmarks • Schedule hours (appointments, slots, etc.) • Staff hours www. e ideba i l l y.c om
  45. 45. Compelling Clinic MetricsRecap1. Measures of Productivity2. Measures of Contribution3. Measures of Quality4. Measures of Business Operations “You can expect what you inspect.” www. e ideba i l l y.c om
  46. 46. Compelling Clinic MetricsAnd finally, remember: If you link compensation to performance… Physicians become very interested in metrics and reporting. • Who • When • Where • How • Why www. e ideba i l l y.c om
  47. 47. Physician Clinic Profitability • David Manning, CPA, CMPE • Manager in Health Care Consulting, Eide Bailly, LLP • T. 701-476-8334 • dmanning@eidebailly.com Thank you for your kind attention. www. e ideba i l l y.c om
  48. 48. Physician Clinic Profitability Who Has the First Question? www. e ideba i l l y.c om

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